Senate panel endorses bill to regulate dry needling treatment

A Senate committee endorsed legislation Wednesday that would allow the Arizona State Board of Physical Therapy to regulate the practice of dry needling, a technique using thin needles to stimulate muscles for pain relief.

The board approved dry needling as an accepted physical therapy practice in October 2013 but said it didn’t have the authority to regulate or make rules for practitioners of dry needling, according to Charles Brown, executive director for the board.

SB 1154, authored by Sen. Kelli Ward, R-Lake Havasu City, would require the physical therapy board to set up standards for training and education by July 1, 2015. It would also allow the board to take disciplinary action against physical therapists who practice dry needling without meeting these qualifications and standards.

The Senate Health and Human Services Committee unanimously approved the bill, forwarding it to the Senate floor by way of the Rules Committee.

Acupuncturists have taken issue with dry needling, saying physical therapists don’t have the proper training with needles to be working on patients.

“To give them the power to self-regulate is like putting the fox in charge of the henhouse,” Wright said.

Acupuncturists are the experts on needling, Wright said, and the board doesn’t have enough experience or knowledge to adequately regulate dry needling.

“I’m sure they have a sincere belief that they know what they’re doing, but they don’t know what they don’t know,” Wright said. “Mistakes happen when people think they know what they’re doing.”

Physical therapists, acupuncturists and legislators met twice for stakeholder meetings in the past few weeks to discuss the views of all parties before the bill was announced.

Ward, a physician, said the meetings and talking to experts helped her arrive at the bill.

“I don’t believe that acupuncture and dry needling are the same procedure and that Arizona has to do a better job in defining each so that neither profession steps on the others’ toes,” Ward said in an email.

Ward said she hopes the bill can help acupuncturists and physical therapists work past their differences.

“I have been trying to find a way to clear up the misunderstanding and allow acupuncturists to continue their practice while we separate and define dry needling that PTs have been doing for many years,” she said.

The physical therapy board doesn’t have an official position on the bill yet because it hasn’t had a chance to meet since the bill was announced Monday, said Brown, the executive director. But he said the process of working with legislators has been positive so far.

“The bill does follow the explanation that the board provided and address the issue of the lack of authority for setting standards,” he said.

Sean Flannagan, a physical therapist who practices dry needling, said the bill is a step in the right direction.

“I think we need standards and rules around it,” he said. “It’s a really good thing for public safety. It shows our board is really regulating our profession as it’s supposed to.”

Flannagan characterized the acupuncturists’ view of dry needling as a “turf war,” with one profession looking to regulate another.

But Pete Gonzalez, executive director of the Arizona Acupuncture Board of Examiners, said calling it a turf war is incorrect.

“It’s a question of safety,” he said. “It’s a question of statutory authority and training.”

The Arizona Acupuncture Board of Examiners doesn’t have an official position on the bill yet, according to Gonzalez, though he said he expects board members to have concerns.

“We’re looking at it from the perspective of: is the general public aware and protected?” Gonzalez said. “We think it’s great that people want to do acupuncture or dry needling because it helps. We’re concerned if they have the adequate training to do it.”

Dry needling vs. acupuncture

Dry Needling: A skilled intervention performed by a physical therapist (PT) that uses a thin filiform needle to penetrate the skin and stimulate underlying neural, muscular and connective tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments.

Definition of acupuncture, according to Arizona Acupuncture Board of Examiners: Puncturing the skin by thin, solid needles to reach subcutaneous structures, stimulating the needles to affect a positive therapeutic response at a distant site and the use of adjunctive therapies.

6 comments

I don’t understand why Kelli Ward has concluded that dry needling is not acupuncture. The American Association of Physical Therapists recently did a worldwide survey on dry needling performed by physical therapists (PTs) and it was found that (PTs) in many countries have been practicing dry needling for many years but they called it acupuncture until only very recently. This poses a question: why did the PTs stop calling it acupuncture?

Jan Dommerholt, a physical therapist who has been teaching dry needling all over the world for MyoPain, testified at the physical therapist oral proceedings in Mississippi on July 24, 2012, that dry needling is acupuncture. He stated for the record that “when done by Chiropractors it is ‘chiro’, when done by acupuncturists it is ‘acupuncture’ and when done by physical therapists it is ‘dry needling’ “. He also stated for the record that when he sees a website that says “dry needling is not acupuncture”, he contacts the website and asks them to remove that phrase because it is not true.

PTs use acupuncture (thin filiform) needles, which by FDA policy can only be sold to licensed acupuncturists. How are PTs getting these acupuncture needles?

Most importantly, patients who see both acupuncturists and PTs recognize that they are getting an acupuncture treatment from PTs, whether it’s called dry needling or not. They want to know why insurance pays for acupuncture done by PTs but not acupuncture done by licensed acupuncturists.

The characterization of the acupuncture community’s concern about the safety risk of needling after only a weekend course as a turf battle is incorrect. If acupuncturists were worried about a turf battle, they would be contesting the various primary care physicians (ND, MD, DO) that have added needling to their scope of practice. Indeed, if PTs get equivalent didactic needling education, supervised clinical training and take a rigorous national certification as acupuncturists have, then there would be meaningful competition. Instead, the concern about a weekend course of training in dry needling (which is an acupuncture technique) is well-founded. Since Colorado allowed dry needling into the scope of PTs, there have already been 3 pneumothorax incidents (one to a Colorado Olympic athlete) in less than a year. Other reports of DN injuries include blood in urine due to bruised kidneys, nerve damage and muscle injury. Yet, despite a few states allowing dry needling to be in the scope for physical therapists, there is no national certification exam for dry needling, nor any nationally agreed upon standards for training, nor any required supervised clinical training. They go directly to performing needling on their patients without oversight or supervisory correction.

The other issue is that the PT board claims needling is in their scope of practice, which is clearly not stated anywhere in their statute. They claim it is an extension of manual therapy. However an Oregon court recently held that physical therapists cannot stick a needle in someone and call it an extension of manual therapy. So it appears that this is still an illegal practice by PTs. To make it legal, the PT board needs to go through the Sunrise review process to add it to their scope. This allows the legislators and public to help set the standard of training which should ideally match the current state standard set for non-primary care physicians (at lest 1200-1850 hours) which is also the national and international standard for needling. By allowing the PT board to set its own standards through last minute legislation, which they have already indicated to be sufficient as 15-30 hours, the legislature and the physical therapy board are endangering the public.

It does not matter that PTs have significant hours of training in western sciences…this act of needling requires its own set of hours in training and education specifically in needling, at least 800 hours of supervised needling, and a certification exam in needling alone. A great number of students in acupuncture schools already have some type of medical degree…many are naturopaths, physicians, physical therapists, nurses and chiropractors who are able to transfer in their western science training, but still have to meet these additional requirements. Without this, there is a much greater incidence of injury. Needling is substantially more safe when performed by an adequately trained practitioner. Acupuncture malpractice rates are only a few hundred dollars annually which attests to both the training and safety of the medicine.

I am pleased to see the interest in acupuncture/needling increasing and I hope that this really means a deepening in knowledge of all that can be done with this tool to help others. With adequate training, it is safe, highly effective, very inexpensive, and utilizable. As with any medicine however, the more you learn, the more you realize there is to learn, and how dangerous it can be with so little knowledge. And so it is with needling/dry needling/acupuncture. Physical therapists performing needling do not know what they do not know…and need to know.

It’s great that Acupuncture has been getting quite a publicity these days…if anyone who utilizes an acupuncture needle….it’s called acupuncture…it’s plain simple….using different terminology (dry needling) to describe its usage is plainly absurd. Billions of people around the world recognize what an acupuncture needle looks like and is utilized to treat a variety of medical conditions. So you can call anything you want…after all…it’s been around for thousands of years and is called acupuncture.

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